Quality Improvement Commons^™

A Conceptual Framework For Clinical Quality Oversight In Telehealth-Enabled Home-Based Urgent Care, Taylor Spencer, Jason P. Williams

HCA Healthcare Journal of Medicine

Background

Home-based urgent care serving frail older adults should aspire to high-quality clinical care with optimal patient outcomes. However, monitoring and ensuring this quality can be challenging. For example, telemedicine and value-based frameworks introduce substantial complexity to clinical quality monitoring.

Purpose

We describe the conceptual framework for a multidimensional quality monitoring program within a national home-based urgent care model.

Framework Description

Medical care was delivered via a multi-state home-based primary, palliative, and urgent care practice serving medically complex Medicare Advantage (MA) populations. Our model of care incorporated distributed clinical and operational teams delivering 24/7 care via telephonic triage, video-enabled encounters, …

Critical Care Catalyst: The Impact Of Trauma Nurse Leads On Mortality, Patient Outcomes, And Throughput, Danielle Brady, Jessica L. Brady, Hannah Dice, Parker Hu

HCA Healthcare Journal of Medicine

Background

Trauma is the leading cause of years of life lost in the United States. Dedicated trauma nurse leaders (TNLs) coordinate resuscitation and streamline care, but data evaluating their clinical impact at level I trauma centers are limited. We evaluated the association between a newly implemented dedicated TNL program and patient outcomes.

Methods

This single-center, preimplementation and postimplementation observational study at an urban level I trauma center compared adult tier 1 and tier 2 trauma activations from the pre-TNL period (January 1, 2017, through April 30, 2020) with the post-TNL period (May 1, 2020, through December 31, 2023; 8 dedicated …

Sedation Minimization And Early Mobility To Prevent Intensive Care Unit Delirium, Alana M. Kugelard

Lynchburg Journal of Medical Science

The purpose of this paper is to synthesize current evidence on sedation minimization, early mobility, and multicomponent care bundles for the prevention of intensive care unit (ICU) delirium in critically ill adults. ICU delirium is a common and serious complication associated with increased mortality, prolonged mechanical ventilation, extended ICU and hospital length of stay, and long-term cognitive impairment, making it a significant safety and quality-of-care concern. A literature review was conducted using PubMed and the Cochrane Library, with search terms including “ICU delirium,” “sedation minimization,” “light sedation,” “early mobilization,” and “ABCDEF bundle.” Filters included adult populations, peer-reviewed studies, randomized controlled …

Practical Implementation Of An Osteoarthritis Treatment Program In A Radiation Oncology Center Within Md Anderson’S Cancer Network, Aaron Shaykevich, Adam Grippin, Warren Floyd, Brady Cripe, Alexander Augustyn, Shalin Shah, Samantha Buszek

Advances in Cancer Education and Quality Improvement

Background: Low-dose radiation therapy (LDRT) for symptomatic osteoarthritis (OA) can add to the workload of radiation oncology services, particularly in small centers with limited capacity and staff. After we launched an OA LDRT program in December 2024, referrals grew rapidly at our rural, single-linac radiation oncology practice at UT MD Anderson’s Cancer Network Partner site (Community Health Network in Indianapolis, IN), leading to long wait times and workflow strain.

Methods: We used load leveling to reserve capacity for cancer care and make OA scheduling predictable. Five 15-minute benign consult slots were set aside each week. Patients then went on a …

From Burnout To Belonging: A Faculty Well-Being Director's Perspective On Leadership, Workplace Culture, Organizational Efficiency, And The Broader Role Of Physician Well-Being, Ajit K. Bisen

Advances in Cancer Education and Quality Improvement

Burnout remains a major challenge in health care, despite increasing investments in physician well-being initiatives. As the faculty well-being director for my department, my perspective on physician well-being has shifted from focusing primarily on individual resilience, mindfulness, and wellness initiatives to recognizing the important roles of leadership, workplace culture, and organizational efficiency. Physician well-being is an essential foundation for high-quality patient care, stronger teams, patient safety, quality improvement, and healthier organizations. Here, I discuss the 3 key shifts in thinking that have influenced my approach as faculty well-being director.

Towards Upstate Well Center: Lessons Learned In Organizational Well-Being Over The Last Decade, Nayla M. Khoury, Asalim Thabet, Kerryanna M. Elhage, Jarrod L. Bagatell, Kaushal Nanavati, Leslie J. Kohman

Advances in Cancer Education and Quality Improvement

Background: Upstate Well has evolved over more than 10 years through the integration of multiple partners, programs, and initiatives. The scope and complexity have increased alongside stronger relationships, shared ownership, and supportive infrastructure.

Methods: This report analyzes implementation lessons learned through program development and impact assessment over 5 years.

Results: Upstate has a growing number of wellness champions across the institution, collaboration among multiple wellness programs, and lessons learned from select programs. Themes include (1) supportive infrastructure, including new full-time equivalent positions to support Upstate Well; (2) active collaboration between stakeholders, and appointed wellness champions in each department; (3) improved …

From Career Alignment To Action: Strengthening Academic Mentoring Through Structured Reflection, Fanni Farago, Julie Izzo, Courtney L. Holladay, Diane C. Bodurka, Michelle Hildebrandt, Suezen Salinas

Advances in Cancer Education and Quality Improvement

Background: As faculty roles and responsibilities become increasingly complex and demanding in contemporary academic medicine, fostering and sustaining faculty well-being has emerged as a critical organizational priority. In response to this need, this brief report describes early insights from the first year of implementation of the Academic Mentoring Program (AMP), a formal and expanding faculty mentoring initiative at UT MD Anderson. Our findings highlight the potential value of incorporating a structured career development assessment (CDA) tool into the mentee intake and engagement effort, evaluating development alignment, professional activities, and organizational expectations.

Methods: We conducted descriptive statistical analysis and qualitative thematic …

Pebbles In The Shoe: A Multidisciplinary Program To Identify And Resolve Workplace Inefficiencies In A Pediatric Oncology Division, Reeja Raj, Kate Gazouleas, Pavilia Francis, Nancy Gordon, Vidya Gopalakrishnan, Amy Heaton, Ishwaria Subbiah, Priti Tewari, Harjeet Singh, Aaron Walton, Shehla Razvi, Martha Askins, Lisa Triche, Karen Moody

Advances in Cancer Education and Quality Improvement

Introduction: Occupational burnout is a significant concern among pediatric oncology faculty and multidisciplinary staff, characterized by emotional depletion, detachment from work, or a diminished sense of professional achievement. Inefficient work processes can be important contributors to burnout. This report describes the implementation and outcomes of Pebbles in the Shoe (also referred to as Pebbles), a pediatric division–wide initiative designed to address workplace concerns and inefficiencies.

Methods: The Pebbles program was developed and led by our pediatric division's wellness task force. Division members were invited to anonymously submit work-related concerns and irritations through a QR code–accessible electronic form. Five discipline-based work …

Aligning Trainee Leave Policies Across Surgical Fellowships: Development Of A Division-Wide Framework For Leave And Program Completion, Helen M. Johnson, Mara B. Antonoff, Kelly K. Bree, Maxwell G. Lewis, Heather A. Lillemoe, Margaret S. Roubaud

Advances in Cancer Education and Quality Improvement

Background: Surgical fellows and program leaders face difficulties navigating parental, caregiver, medical, and personal leave due to variation in policies. A Division of Surgery (DoS) Trainee Leave and Parental Support Task Force was convened at The University of Texas MD Anderson Cancer Center to review existing requirements and develop a harmonized framework for trainee leave and fellowship program completion.

Methods: The Task Force conducted a comprehensive review of policies relevant to surgical fellow leave and graduation requirements, identified best practices, and drafted a DoS policy. The policy was refined iteratively through engagement with key stakeholders, including program directors, department chairs, …

Creating A Culture Of Well-Being By Removing Barriers To Participation In A Multi-Campus Cancer Center, Adam Siegman, Miranda M. Phillips, Jennifer Bickel

Advances in Cancer Education and Quality Improvement

Background: Healthcare professionals in geographically distributed cancer care settings may face barriers to accessing workforce well-being resources due to geographic distance, staffing constraints, and operational demands. Disconnect & Refresh was developed to improve access to restorative wellness opportunities across community-based cancer care sites.

Methods: Disconnect & Refresh was implemented at The University of Texas MD Anderson Cancer Center across 4 Houston area locations. The initiative included BeWell Paws, virtual reality meditation, chair yoga, and creative wellness activities delivered during the workday. Participation was voluntary and tracked through employee badge scans. Participants were invited to complete an anonymous post-event survey, and …

Faculty Growth Through Academic Career Development Committees, China Crowder, Rebekah Filson, Elizabeth Grubbs, Carin Hagberg, Anne Tsao

Advances in Cancer Education and Quality Improvement

Academic medical centers face ongoing challenges in providing structured, career -stage-–specific faculty development, mentorship, and leadership opportunities that effectively engage faculty throughout their academic careers. The Academic Career Development Committees at The University of Texas MD Anderson Cancer Center represent a structured, faculty-driven model designed to promote professional growth, mentorship, and leadership engagement across all career stages. Grounded in established principles of faculty development and mentorship in academic medicine, the Academic Career Development Committees foster cross-level collaboration, inclusive participation, and intentional skill-building. Outcomes were measured through participant evaluations, attendance and participation trends, mentorship engagement indicators, and qualitative feedback gathered from …

Leadforward: A Department-Based Leadership Development Program To Support Workforce Well-Being, Leisa A. Bryant, Denise Marshall, Loreal Williams, Miranda M. Phillips

Advances in Cancer Education and Quality Improvement

Introduction: Leadership development is increasingly recognized as an important strategy for supporting workforce engagement, professional growth, and succession planning in healthcare settings. To address leadership development needs within Food, Nutrition, and Patient Transportation (FNPT) departments, a structured leadership development program, LeadForward, was developed for emerging and midlevel leaders.

Project Description: LeadForward was implemented within the FNPT departments at a comprehensive cancer center. Ten participants completed the inaugural cohort. The curriculum was organized into 6 instructional modules designed to develop leadership competencies among emerging and midlevel leaders. Leadership outcomes were assessed using pre- and postprogram self-assessments across 14 leadership competency …

Standardized Preprocedure Protocolling Of Stereotactic Breast Biopsies Enables Device-Level Supply Chain Forecasting: A Multisite Quality Improvement Analysis, Megan Kalambo, Mike Everding, Maria Montemayor, Falguni Patel, Mohit Nath

Advances in Cancer Education and Quality Improvement

Background: Breast imaging depends on single-use, vendor-proprietary consumables produced by a concentrated set of manufacturers. During supply shortages in 2026, healthcare organizations faced urgent pressure to shift from reactive to proactive inventory management. Stereotactic breast biopsy needle shortages revealed that traditional forecasting based on procedure volume lacks the granularity needed for device-specific demand. We aimed to enable device-level forecasting through standardized preprocedure protocolling.

Methods: In a retrospective analysis of 1,456 stereotactic biopsies across 4 breast imaging sites (June 2025 to June 2026), compliance with a standardized electronic protocolling tool that captured lesion count and needle size (standard vs. petite) was …

Critical Daily Dose Warning Optimization In An Electronic Health Record At A Tertiary Cancer Center, Mckenzie Erwin, Sadika Eslaminejad, David Perez, Jesni Mathew

Advances in Cancer Education and Quality Improvement

Objectives: Clinical decision support is a form of health information technology utilized by electronic health records (EHRs) to reduce prescribing errors. The challenge of incorporating clinical decision support into medication workflows is balancing alert fatigue with clinical appropriateness. At our 777-bed tertiary cancer center, one form of interruptive clinical decision support is critical dose warnings that appear when the ordered dose deviates by a defined threshold from the maximum dose. Our tertiary cancer center relies on a third-party data vendor to provide maximum dose limits that are integrated into the EHR medication ordering process. At the time of project initiation, …

Implementation Of A Low-Cost Tobacco-Free Intervention In A Permanent Supportive Housing Program To Address Cancer Disparities Among People Who Have Experienced Homelessness, Ammar D. Siddiqi, Phoebe Wong, Cathy Crouch, Lorraine R. Reitzel

Advances in Cancer Education and Quality Improvement

Objectives: Permanent supportive housing residents who have experienced homelessness use tobacco products at elevated rates, contributing to higher cancer risk. Agencies that provide wraparound support services to this group are committed to rebuilding their stability by improving their health. Yet, their delivery of tobacco screening and cessation care is limited, as is information about their clients’ tobacco use behaviors. Here, we evaluated a low-cost intervention for an Albert Schweitzer Fellowship project conducted in a permanent supportive housing program with 650 adults who had experienced homelessness in Houston, Texas.

Materials and Methods: Between August 2024 and February 2025, client-facing staff members …

Evaluation Of Shortened Irinotecan Infusion Times And Adverse Effects Incidence For Gastrointestinal Medical Oncology Patients, Rachel N. Ochs, Daniel J. Donovan, Neha A. Betrabet, Wendy M. Covert

Advances in Cancer Education and Quality Improvement

Background: Irinotecan, a topoisomerase I inhibitor, is commonly used to treat gastrointestinal cancers. The infusion time of irinotecan is usually over 90 minutes; however, studies support the safety and feasibility of 30-minute infusions. A shortened infusion duration may improve patient quality of life, optimize infusion chair utilization, and reduce wait times. Faster infusion rates may increase the risk of acute cholinergic side effects, reported in up to 50% of patients (all grades). Current institutional practice in the gastrointestinal medical oncology (GIMO) clinic involves administering irinotecan over 90 minutes and using atropine as needed for reversing cholinergic symptoms. For patients who …

Unlocking Faculty Potential: A Quasi-Experimental Study Of Coaching And Academic Performance In Health Care Settings, Amanda Woods Herron, Katelyn J. Cavanaugh, Michelle Figliuolo Deveau, Courtney L. Holladay

Advances in Cancer Education and Quality Improvement

As faculty in academic medicine face mounting demands to excel in clinical care, research, teaching, and administrative responsibilities, interventions that support professional sustainability are increasingly critical. Coaching has emerged as a promising developmental strategy within health care leadership, yet its impact on research and clinical outcomes in academic medical centers remains underexplored. This quasi-experimental study evaluated the effectiveness of a coaching program using intentional change theory (ICT) as a conceptual framework. ICT emphasizes sustainable personal transformation through alignment between the ideal self and professional goals. We examined a sample of 189 coached clinical faculty and 200 matched peers who had …

Why Should A Data-Driven Cancer Center Prioritize Well-Being?, Peter Pisters

Advances in Cancer Education and Quality Improvement

No abstract provided.

The Future Of Wellness In Health Care, Jennifer Bickel

Advances in Cancer Education and Quality Improvement

No abstract provided.

Psychological Adaptation In Colorectal Cancer Survivors: Pilot Study Findings, Anuja L. Sarode, Emily M. Su, Amber Kerstetter-Fogle, Steve Paciorek, Erica L. Laipply

HCA Healthcare Journal of Medicine

Background

In this pilot study, we examined psychological impacts of colorectal cancer (CRC), focusing on cancer-related posttraumatic stress disorder (CR-PTSD) symptoms, posttraumatic growth (PTG), and their relationship with coping strategies in surgically treated CRC patients.

Methods

This prospective pre- and postoperative pilot study assessed CRC patients at 2 time points, pre- and postoperative. Psychological symptoms were evaluated using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5) and the PTG Inventory Short Form (PTGI-SF). Coping strategies were assessed using the Brief Coping Orientation to Problems Experienced (COPE) instrument. Changes in CR-PTSD, PTG, and coping …

Independent Associations With Research Productivity Among U.S. Academic Ophthalmologists Using The Us-Aofd, Brenton T. Bicknell, Josephine Rudd Zhong Manis, Yejin Heo, Haley Chishom, Lance Dzubinski, Taylor L. Aaserud, Alvina Liang, Shayan Massoumi, Thanushri Srikantha, John Stoffer, Guihua Zhai, Basil K. Williams Jr, Steven E. Brooks, Robert Tauscher

Journal of Academic Ophthalmology

Background: Scholarly productivity is a key marker of achievement in academic ophthalmology, influencing promotion, research support, and leadership opportunities. Prior studies have reported variation by gender, subspecialty, and rank, but few applied regression methods to identify independent predictors.

Purpose: To evaluate demographic, academic, and subspecialty factors associated with research productivity among U.S. academic ophthalmologists and to identify independent predictors through multivariable regression.

Methods: This cross-sectional study included 4,028 ophthalmologists across 126 accredited U.S. residency programs using the U.S. Academic Ophthalmology Faculty Database (US-AOFD). Faculty demographics and academic information were obtained from institutional websites, and bibliometric data (publications, …

The Efficacy Of Transversus Abdominis Plane Block As An Adjunct To Spinal Anesthesia For Cesarean Delivery: An Evidence Synthesis And Implementation Toolkit, Alyssa Hebert, Alex Potts, Gabriela Robertson

Graduate Theses, Dissertations, and Capstones

Postoperative pain hinders cesarean delivery recovery and overall patient experience. Although spinal anesthesia with intrathecal opioids remains the standard of practice, associated side effects and concerns regarding opioid exposure highlight the need for effective opioid-sparing strategies. Anesthesia providers play a critical role in advancing postoperative pain management through evidence-based protocol development, provider education, and interdisciplinary collaboration to optimize maternal outcomes. The transversus abdominis plane (TAP) block provides somatic analgesia to the anterior abdominal wall by targeting the thoracolumbar nerves (T6–L1) and has increasingly been incorporated into multimodal postoperative pain management strategies for abdominal surgery. Nevertheless, a gap remains in obstetric …

High-Flow Nasal Cannula Oxygen Therapy Versus Standard Oxygen Therapy On Perioperative Outcomes In Patients Undergoing Transcatheter Aortic Valve Replacement, Kirsten B. Whiteside, Jacqueline M. Case

Graduate Theses, Dissertations, and Capstones

Abstract 

Background and Purpose: Transcatheter aortic valve replacement (TAVR) is increasingly performed under monitored anesthesia care (MAC) to facilitate faster recovery and reduce complications associated with general anesthesia. Standard oxygen therapy (SOT) may be insufficient in maintaining adequate oxygenation in this high-risk population. High-flow nasal cannula (HFNC) therapy has emerged as a potential alternative. This literature review evaluates the effects of HFNC compared with SOT on perioperative outcomes in patients undergoing TAVR under MAC. 

Methods: A comprehensive review of the literature was conducted to identify studies evaluating HFNC versus SOT during TAVR procedures performed under MAC. Six studies met inclusion …

Reducing Stress Through Low-Carbohydrate Nutrition Education In Emergency Department Staff – A Quality Improvement Project, Hassan Oman Gomar

Loma Linda University Electronic Theses, Dissertations & Projects

Introduction and Background

Emergency department staff often face job-related stress, which can lead to burnout, reduced compassion satisfaction, and adverse effects on patient care. Loma Linda University Health (LLUH) offers support programs, including Care for the Caregiver (C4C) and the Living Whole Employee Wellness program, that provide emotional and general wellness resources. While these programs are helpful, they do not offer practical solutions for everyday stress. There is a need for simple, lasting, and food-based ways to help staff manage stress and perform better. Recent research shows that eating patterns, especially high intake of processed carbohydrates, can alter energy and …

Optimizing Esophagogastric Junction Assessment And Antisecretory Medication Documentation During Egd: A Preintervention Quality Improvement Analysis, Vikram R. Ekambaram, Maneera Chopra, Wasseem Skef

Summer Research Program Abstracts

No abstract provided.

Timing Matters: Safe And Timely Insulin Administration, Katlyn Lenox

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Timely insulin administration is essential for safe inpatient diabetes management and is strongly associated with improved glycemic control and fewer adverse events. Despite ADA recommendations to administer insulin within 30 minutes of point‑of‑care (POC) glucose testing, internal data showed only 44% compliance, with an average delay of 44 minutes. These delays increased the risk of hypo‑ and hyperglycemia and highlighted the need for workflow redesign and strengthened nursing processes.

Aim of the Project: To increase the percentage of insulin doses administered within 30 minutes of POC glucose testing, reduce adverse glycemic events, enhance patient safety, and align practice with …

Skin Is In: Promoting Breastfeeding Through Immediate Cesarean Skin-To-Skin, Autumn Spencer

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) and the American College of Obstetricians and Gynecologists identify immediate, uninterrupted skin-to-skin contact as a standard of care that improves neonatal stability, breastfeeding outcomes, and maternal satisfaction. Despite these recommendations, timely initiation following cesarean birth remains inconsistent. At the project site, skin-to-skin initiation averaged 72 minutes after birth, exceeding the 10-minute benchmark, and exclusive breastfeeding rates were below the national standard of 70%. Contributing barriers included workflow variability, unclear role expectations, and inconsistent communication.

Aim of the Project: The aim of the project was to improve infant and maternal …

Dnp Final Report: Enhancing Radiation Oncology Training For Advanced Practice Providers, Katherine A. Bukolt

DNP Final Reports

Background: Rising cancer incidence and improved survivorship are straining the oncology workforce, increasing reliance on Advanced Practice Providers (APPs). However, there is a lack of standardized educational resources for APP radiation oncology training across practice settings. Most APPs receive variable, resource-dependent, and on-the-job training. Evidence shows that the lack of standardized training leads to gaps in foundational knowledge, reduced confidence in toxicity management, inconsistent role development, and variable satisfaction with training and transition into practice.

Purpose: This quality improvement project evaluated the feasibility of implementing an 18-module Advanced Practice Radiation Oncology (APRO) asynchronous online curriculum to standardize APP radiation oncology …

The Power Of Proximity: Driving Hand Hygiene Compliance Through Sanitizer Placement, Jennifer E. Jones, Eric Van Middendorp, Leanne Wendt

Posters

Hand hygiene is the cornerstone of infection prevention in healthcare settings and is particularly critical in the Neonatal Intensive Care Unit (NICU) where patients are highly vulnerable due to immature immune systems and frequent exposure to invasive procedures. Healthcare associated infections (HAIs) remain a significant cause of morbidity and mortality among neonates. Evidence consistently identifies proper hand hygiene as the single most effective intervention to reduce HAIs in NICUs. Despite its simplicity, compliance among healthcare workers is often suboptimal, influenced by factors such as workload and accessibility of hand hygiene resources.

Operation No Noro: A Multidisciplinary Approach To Containing A Norovirus Outbreak In An Inpatient Rehabilitation Unit, Donika Marko, Roula Hilli, Priscila Bercea, Pamela S. Bozigar, Levi Launder, Stephanie Robertson, Trini A. Mathew

Conference Presentation Abstracts

Norovirus is a highly contagious viral gastroenteritis and can rapidly spread in healthcare settings, particularly in congregate environments such as inpatient rehabilitation units. In March 2025, a cluster of acute gastrointestinal illness was identified on a 34-bed inpatient rehabilitation unit within a 150-bed acute care hospital. Eight patients developed: • Nausea • Vomiting • Diarrhea • Abdominal pain Due to shared spaces, communal therapy activities, and high patient interaction, rapid intervention was initiated to prevent further spread.